Vacation Bible School - Madison East Adventist Church

Parent Information

This form must be filled out by a parent or guardian.

Parent or Guardian Name(s) *Please enter First AND Last names.

Home Address *Enter full address, including: Street, City, State, ZIP0 / 200

Contact Phone *Enter best contact number.

Email Address *Enter best email address for contact.

Home ChurchName of church where you regularly attend.0 / 200

Custodial ArrangementIf anyone else aside from you shares custody, please describe.0 / 300

Emergency Contact *Enter name of person to contact if you're unavailable.

Phone *

Choose Friend or Relative *

Child Information

Child Details

Child's Name *First and Last Name

NicknameEnter the preferred nickname if applicable

Child's Gender *MaleFemale

Child's Age *

Child's Birthdate

Allergies or Medical ConditionsPlease explain any medical conditions that we should be aware of

Special Needs or Disabilities *Answer yes for anything physical, or developmental.YesNo

Special Needs

You've indicated that your child has special needs or disabilities. Please be sure to fill out the Special Needs Survey on the following page to better help us serve your child.

Special Needs Survey

You indicated that your child has special needs, please fill out the following survey, and make sure you give your consent if you agree that your answers can be shared with the volunteers that will be teaching your child.

Special Needs

Child's Name *First and Last name

Medical or Developmental Diagnosis *Briefly describe your child's special needs.

Primary Means of CommunicationBriefly describe your child's preferred way of communicating with others.

Additional information regarding my child's allergies or food sensitivities.

My child's favorite activities and interests are:

My child avoids doing, or becomes easily frustrated with the following activities:

If my child becomes overwhelmed or frustrated, they'll respond best to:

My child's strengths are:

My child needs help with:

What suggestions do you have that may help us create the best experience for your child?

What information would you like us to share with other children to help them better know, accept and understand your child?

Finish

Thank you for completing the Registration Form, please take a minute to review and make any necessary changes.

Vacation

Bible School

Join Us For These Exciting Topics!

Day 1 - May 30th

Day 2 - June 16th

Day 3 - July 11th

Day 4 - August 8th

Day 5 - August 22nd

Contact

Registration Form